Healthcare Provider Details

I. General information

NPI: 1104921972
Provider Name (Legal Business Name): LUIS A. ESPINET D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W LAKE MARY BLVD #106
LAKE MARY FL
32746-3501
US

IV. Provider business mailing address

2500 W.LAKE MARY BIVD. #106
LAKE MARY FL
32746
US

V. Phone/Fax

Practice location:
  • Phone: 407-328-6411
  • Fax: 407-328-6444
Mailing address:
  • Phone: 407-328-6411
  • Fax: 407-328-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN14288
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN14288
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2240
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: